Abstract:Objective To summarize the experiences of single stage repair of interrupted aortic arch （IAA） associated with cardiac anomalies. Methods From Jan. 2000 to Dec. 2005, 48 patients admited in hospital and 35 patients were operated, the mean age at operation was 1.1 years. The associated anomalies included 23 cases of ventricular septal defect, 2 cases of transposition of great arteries, 3 cases of aortopulmonary window with aortic origin of right pulmonary artery, 2 cases of truncus arteriosus, 2 cases of double outlet right ventricle, 2 cases of stenotic fifth arch and 1 case of aberrant origin of right subclavian artery with mild hypoplastic decending aorta. Among them, 34 patients underwent single stage repair and 1 kid underwent palliative correction. Results There were 4 surgical deaths. The sequelae included one diaphragm paralysis and one 3rd degree of atrioventricular block. Only 5 kids recurred mild stenosis of aortic arch anastomosis and 2 death occurred during 3 months to 4 years of follow-up. Conclusion Though early surgical mortality for primary single stage repair is now relatively low, if appropriate interventions has been accomplished during perioperative period, but outcomes of IAA remain of concern, especially in patients with associated lesions.
Objective To investigate the changes of renal medulla aquaporin 2 expression and morphological changes of epithelia of collecting tube after bile duct recanalizaiton operation. Methods Thirty rats were divided into two groups randomly. Common bile duct ligation was performed on 20 experimental rats with silicon tubes 2 mm in extre-diameter, and sham operation on the other 10 rats. Seven days later, bile duct recanalizaiton was performed on obstructive jaundice group and sham operation on contrast group. Experimental rats were divided into two subgroups randomly. Half of them were killed immediately and the others would be killed 24 hours later. Serum of each rat was collected to detect hepatic function and renal function. Renal medulla was fixed for microscopic examination and was kept in the -80 ℃ refrigerator for aquaporin 2 expression measurement by Western blot technique. Results All of the animals accomplished the experiment smoothly. Golden ascites were found in the rats of obstructive jaundice group. Twenty-four hours after recanalization, serum bilirubin levels decreased 〔(45.95±8.39) μmol/L〕, P＜0.01, and there was no significant change in blood urine and creatine level. Compared with sham operation group (21 966.20±1 544.70), expression of aquaporin 2 decreased significantly after common bile duct ligation in obstructive jaundice group (15 665.30±1 181.85), P＜0.01. After recanalizaion, the expression of aquaporin 2 in obstructive jaundice group increased (19 490.80±4 239.32), P＜0.01. Conclusion Common bile duct obstruction would lead to epithelium injury of renal collecting tube, and down regulate the aquaporin 2 expression.
The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.
Perioperative management of 58 hypertensive patients suffering from surgical disease is reported. We emphasize that before operation the blood pressure should be adequately controlled, and heart function promoted. It is safer that the diastolic pressure is controlled under 14 kPa before operation. During operation we strictly observe the change of the blood pressure and manage it in time. Analgesic and antihypertensive agents are used after operation.
ObjectiveTo evaluate rational use of antibiotics for hernioplasty in perioperative period by intervention-control study in order to provide a foundation for the clinical antibiotic use and management. MethodsThe data of the preventive use of antibiotics for hernia patients from January to October, 2010 in perioperative period were collected and compared. Interventions on patients from January to October, 2011 were carried out. ResultsIn the intervention group, the first three antibiotics used were changed from azlocillin, mezlocillin and aztreonam before intervention to cefazolin, clindamycin and azlocillin after intervention. Before intervention, antibiotics were first used after surgery for surgical prophylaxis, while after intervention, antibiotics were first used within 30 minutes before surgery or at the start of induction of anesthesia. The preventive medication time decreased from (3.50±2.07) days to (0.88±1.07) days (t'=14.601, P=0.000), the hospitalization days of post-surgery decreased from (5.17±1.90) days to (3.77±1.61) days (t'=7.313, P=0.000), the cost of antibiotics decreased from (342.39±415.50) yuan to (54.08±80.83) yuan (t'=8.831, P=0.000), the percentage of the cost of antibiotics in expenses for medicine declined from (47.53±25.51)% to (12.49±13.46)% (t'=15.776, P=0.000), and the percentage of the cost of antibiotics in hospitalization expenses declined from (6.59±5.49)% to (1.07±1.35)% (t'=12.662, P=0.000). The difference in inappropriate use of antibiotic drugs before and after prevention, such as choice of preventive drugs, preoperative medication occasion, course of postoperative medication and no indication of drug combination, had statistical significances (P<0.05). ConclusionThe intervention-control study shows that the rational use of antibiotics for hernioplasty in perioperative period can be improved, and the average hospitalization days and the cost of antibiotics can be reduced by intervention.
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
Objective To review the value of imaging assessment for perioperative period of liver transplantation. Methods The related literatures in recent years were reviewed, and the applications of various kinds of radiological techniques in perioperative period of liver transplantation and radiological strategies of major complications after liver transplantation were summarized. Results Transplantation has become an effective option for treatment of patients with irreversible severe liver dysfunction. Radiological assessment supplies prompt and accurate information for clinic to increase the success rate and reduce the complications. So it plays an irreplaceable role. Conclusions Radiology assessment is important for screening donors and recipients before liver transplantation， following up and monitoring the complications. The doctor of imaging department could grasp the different imaging appearance in perioperative period of liver transplantation.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
There are a variety of invasive or non-invasive methods for monitoring cerebral blood flow and cerebral metabolism in patients during operation with anesthesia, and different methods have their own scope of use. Transcranial Doppler can be used to monitor high-risk patients with intraoperative cerebral blood flow autoregulation dysfunction and patients with special positions during operation because of its convenience, continuity, and strong repeatability. Changes in cerebral blood flow detected by transcranial Doppler may be associated with postoperative central nervous system complications in patients. This article reviews the application of transcranial Doppler monitoring of cerebral blood flow in operation with anesthesia, aiming to provide a certain basis for the promotion of this technology in operation with anesthesia.
ObjectiveTo investigate predictive value of intraoperative graft flow measurements during off-pump coronary artery bypass grafting (OPCAB) for early clinical prognosis. MethodsWe retrospectively analyzed the clinical data of 133 patients with three-vessel disease who underwent OPCAB in the Department of Cardiac Surgery of People's Hospital of Peking University in 2013 year. There were 103 males and 30 females with mean age of 62.84±7.13 years. Pulsatility index (PI) and mean flow were measured using a flow metre before the end of surgery. Then the total graft flow and the average graft flow were calculated. Univariate, bivariate correlation and logistic regression analysis were performed for statistical analysis. ResultsThe blood flow and PI of LIMA-to-LAD graft was respectively 28.69±16.90 ml/min and 2.70±1.39, and the total graft flow and the average graft flow was respectively 79.94±37.20 ml/min and 35.55±16.75 ml/min. The PI of LIMA-to-LAD graft was significantly correlated with serum cardiac troponin I(cTnI)level in 12 hours, with the highest serum cTnI level within 48 hours, with ICU stay and with ventilator time (P<0.01), but the correlation was not strong(coefficient correlation <0.4). Compared with the patients without perioperative myocardial infarction (PMI), the blood flow of LIMA-to-LAD graft, the total graft flow and the average graft flow were lower in the patients with PMI (P<0.01). Logistic regression analysis revealed that the total graft flow was an independent predictor of PMI (P=0.004, RR=0.950, 95%CI 0.918-0.984). ConclusionIntraoperative graft flow measurements during OPCAB can predict shortterm prognosis. The lower total graft flow is a risk factor for PMI.